Petition for Initiation and Membership
Ancient Arabic Order
Nobles of the Mystic Shrine Rhode Island Shrine Center
To the Illustrious
Potentate, Officers and Nobles of Rhode Island Shrine Center, situated in the Oasis of Cranston, Desert of Rhode Island. I, the undersigned,
hereby declare that I am a Master Mason in good standing in ______________________ Lodge No. A.F.&A.M located at ______________________________.
Furthermore, I do not now, and never will, hold membership in or allegiance to, any Body claiming to be Masonic that has been declared
clandestine; that I have resided within the jurisdiction of your temple, or in unoccupied territory, not less than 6 months, as required
by the Constitution of The Imperial Council; and that I am not under suspension or expulsion in the Body prerequisite to this Order,
and respectfully pray that I may be made a Noble of the Mystic Shrine, and become a member of your Temple.
If I be found worthy, and
my request granted, I promise to conform to all Ceremonies, Engagements, Constitutions, Regulations and Edicts of the Imperial Council
together with those of your temple.
Birthplace ____________________________ Date of Birth ____________ Age ____________
Profession
or occupation _________________________________________ Hat Size ____________
Have you previously applied for admission to any Temple
of the Order? ___________
If so, what Temple? ___________________________ When? ___________________
Were you ever a DeMolay? ___ If
so, what Chapter?__________________________________________
Profession or occupation _________________________________________
Residence
Address ________________________________________________
_______________________________________________________________
Mail Address
_____________________________________________________
Date _____________20 ____
Signature ________________________________________________________
Print Full Name Here _____________________________________________
Recommended and Vouched for on the Honor of
Noble ____________________________________________________________
Noble ____________________________________________________________
Return to: Recorder, Rhode Island Shrine Center, One Rhodes Place,
Cranston, Rhode Island 02905
Phone: Home ________________________ Work ________________________
